Fourth Cir. Remands Disability Denial for Cox Worker to Aetna

Aetna must revisit its decision denying long-term disability benefits to a former Cox Enterprises, Inc. employee because it ignored evidence used to recertify his Social Security benefits, a three-judge panel at the Fourth Circuit said.

The case highlights two trends in challenges to benefits denials under the Employee Retirement Income Security Act—the disparity in approvals between the Social Security Administration and private insurers, as well as judges’ remands back to insurers after concluding the company abused its discretion.

Aetna initially discounted Jeremy Smith’s Social Security recertification because it was not provided details from a physical exam, but even after receiving ...